Standards for public agencies

2020 Edition

Opioid Treatment (PA-OTP) 15: Withdrawal

Persons served participate in the development of an appropriate withdrawal schedule and receive the necessary support to prevent relapse.
2020 Edition

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Individuals who participate in Opioid Treatment Programs improve social, emotional, and vocational functioning, achieve optimal productivity, and attain the recovery they seek.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for medical withdrawal
  • Procedures for administrative discharge
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records


PA-OTP 15.01

Medical withdrawal from opioid treatment medication is:
  1. a voluntary and therapeutic process planned for by the individual and a physician; or 
  2. conducted in response to an individual's request, but against medical advice (AMA).


PA-OTP 15.02

Medical withdrawal practices include:
  1. dose reduction at a rate well tolerated by the person and in accordance with accepted medical practices;
  2. periodic assessments of mental status;
  3. an assessment for pregnancy for women of childbearing age;
  4. availability of counseling and other support services; and
  5. discontinuation of withdrawal and resumed maintenance therapy, in the event of impending relapse.


PA-OTP 15.03

Individuals that undergo medically supervised withdrawal AMA:
  1. are provided with information about the risks of discontinuing treatment and information about and referral to alternative treatment programs;
  2. can be readmitted to the program within 30 days without repeating the initial assessment; and
  3. are considered for maintenance treatment when withdrawal fails.


In the case of a pregnant individual the agency should keep the organization providing prenatal care informed of the individual's status consistent with privacy standards.


Reason for seeking discharge and steps taken to avoid discharge should be noted in the case record.

Fundamental Practice

PA-OTP 15.04

When other interventions were proven unsuccessful, a program may determine that administrative withdrawal is necessary, including: 
  1. a humane withdrawal schedule based on sound clinical judgement; and
  2. referral or transfer to a suitable, alternative treatment program, whenever possible.


The agency must determine on a case-by-case basis its responsibility to continue providing services to persons whose third-party benefits are denied or have ended and who are in critical situations.


A suggested schedule for medically supervised administrative withdrawal is a minimum of 30 days with adjustments made depending on clinical factors. Since administrative withdrawal is conducted over a short timeframe and associated with poor prognosis connecting individuals to alternative treatment programs is critical.
Examples: Administrative discharges are usually involuntary and may occur for reasons such as nonpayment of fees, incarceration, or disruptive conduct or behavior such as violence, dealing drugs, repeated loitering, and flagrant noncompliance.